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11.02.2015 16:32    Comments: 0    Categories: Weekly Parashah      Tags: torah  shabbat  parashah  mishpatim  

On the Practice of Medicine

Some Jewish sects during the Second Temple period were of the opinion that administering medical treatment to one’s fellow human is forbidden, insofar as an illness or injury was viewed as decreed by the Holy One, blessed be He, and it was not for humans to intervene and attempt to thwart the decree of the Ruler of the Universe. Among these sects were the Essenes. In modern times, such an approach is found notably among the Christian Scientists.

Indeed, in Jewish law, from the Bible onwards, there clearly is no such prohibition against medical treatment. Quite the contrary, it is considered a good deed and an obligation. The Sages interpreted the verse in this week’s reading, “he must pay…for his cure,”[1] as an indication that the practice of medicine is permitted.[2]

Several explanations were given by exegetes why special permission had to be given to practice medicine, something not encountered with regard to any other profession or occupation: 1) lest the physician say, “Why should I care about the patient’s misery?” for fear he do something wrong and end up causing the person’s death unintentionally;[3] 2) so that physicians could work for pay and would not have to administer medicine only for free;[4] 3) so that physicians could not only treat man-caused ailments but also ailments that come from heaven, which might seem an attempt to undo the decrees of the King of the Universe;[5] 4) to teach us that if one physician fails to find a cure it is legitimate to turn to another physician, and that we not say the first physician’s failure is indication of the will of the Almighty;[6] 5) because the essence of medicine and its ways of treatment are subject to doubt, although man has no other option, and so thus the world behaves.[7]

The prevalent explanation of why explicit permission had to be given to practice medicine was the need to counter the presumption that engaging in healing a sick or injured person might constitute a contradiction of the Almighty’s decree, for after all, the Holy One, blessed be He, is the one who “wounds and heals” (see Deut. 32:39). Therefore, the Torah gave explicit permission to engage in medicine, thereby proving that such action should not be seen as contradicting the will of the Holy One, blessed be He,[8] for although everything is in the hands of Heaven, and divine providence extends over all creatures in the world, nevertheless the will of the Holy One, blessed be He, is for the physician to be the Lord’s emissary when it comes to healing. Therefore the Holy One, blessed be He, gave human beings the intellectual capacity to diagnose diseases, invent medications and methods of treatment, cure disease and heal injuries. At the same time, each and every person must know that ultimately all depends on the Holy One, blessed be He, so that all should put their trust in Him.

Indeed, there is no contradiction between believing in individual divine providence, from which stems the belief that illnesses and their cures are in the hands of the Holy One, blessed be He, alone, and the belief that it is a positive command for the physician to try to the best of his or her ability to cure the patient using the means that the natural world puts at his disposal:

Just as the Lord created food to sustain the healthy, so, too, He created medicines to cure the sick. And just as it ill-behooves a person to say, “I do not wish to eat or drink, for if it has been decreed that I shall live, then I will live, and if that I die, then I will die”—for sure such a person jeopardizes his life, for the Lord desires us to live, but through food. Likewise, the sick person who says, “I will not take medicine, etc.,”—such a person also jeopardizes his life, for the Lord desires him to live, but through medication.[9]

The foolhardy pious one who rejects the assistance of the physician and relies solely on the Lord’s succor is like a hungry person who rejects eating bread and hopes that the Lord will protect him and cure him of the ailment known as hunger.[10]

Several sources present an ideological explanation of the physician’s actions:

Once Rabbi Ishmael and Rabbi Akiva were walking around in Jerusalem, and another person was with them. They chanced upon a sick person who said to them, “Gentlemen, tell me how I can cure myself.” They answered, “Do such and such, until you are better.” He said to them, “Who caused me to be stricken?” They said, “The Holy One, blessed be He.” He said, “So you are interjecting yourselves in matters not yours; He smote me, and you propose to cure me?! Are you not contravening His will?” They said to him, “What is your occupation?” “A farmer. Do you not see the sickle in my hand?” They said to him, “Who created the vineyard?” “The Holy One, blessed be He,” he answered. They said to him, “You are interjecting yourself in matters not yours; He created it, and you reap its fruits?” He said to them, “Do you not see the sickle in my hand? Were it not for my ploughing and pruning, fertilizing and weeding, nothing would be produced.” “Fool of the world,” they said to him, “have you not heard what it says of your occupation: ‘Man, his days are like those of grass’? Just as the tree, without weeding and fertilizing and ploughing, does not sprout, and if it happens to sprout but does not drink water and receive fertilizer, it does not survive, so too with the body: the fertilizer is the drug and various medications, and the farmer is the physician.” “Please,” he said to them, “do not punish me.”[11] Say not that insofar as the Holy One, blessed be He, decreed the sick person to remain ill and be confined to bed, therefore the person should not attempt to seek cure. It is not so, for the poor person is the patient and the educated person, the physician; and even though the Holy One, blessed be He, Himself confined the sick person to his sick-bed, nevertheless it is His will that the physician attempt to cure him and help him shake off the fetters of his disease.[12]

The Halakhah asserts that the Torah not only permits the physician to practice medicine, but even requires him to do so,[13] considering it in the class of pikuah nefesh (saving life). If he refrains from doing so, he is considered to be spilling blood,[14] for once permission is given to engage in medicine, doing so constitutes the great mitzvah of saving life and helping mankind. The physician is considered an emissary of the Holy One, blessed be He, who helps refine and improve His world, insofar as Judaism perceives medicine to be a mission and a destiny.

The commandment obliging the physician to treat the sick is derived from various sources in the Torah. The most widely cited sources are: 1) the law requiring the return of lost property, subsumed in the interpretation of the verse, “and you shall restore it to him,”[15] extending this to include loss to one’s body,[16] so when one sees someone endangered, one is obliged to come to the person’s rescue with one’s body, wealth, or wisdom;[17] 2) from the verse, “Do not stand upon the blood of your fellow”;[18] 3) from the verse, “Love your fellow as yourself,”[19] and others.

In light of all this, it has been asked why, if the practice of medicine is a mitzvah, the Torah felt it necessary to grant explicit permission. The explanation is offered that without this permission we would not know to generalize to the obligation to practice medicine along with other things deduced, for the duty to practice medicine is not stated there explicitly; but once we deduce the right to practice medicine, then it necessarily becomes a duty on the basis of any of the above-cited verses.[20]

Translated by Rachel Rowen

[1] Ex. 21:19.

[2] Berakhot 60a; Bava Kama 85a.

[3] Nahmanides, Torat ha-Adam, Sha`ar ha-Sakanah.

[4] Rabbi Yaakov of Orleans, cited in Tosf. Rabbi Judah he-Hassid, Berakhot 60a, s.v.mi-kan,” and Tosf. Rosh, loc. cit.

[5] Tosf. Rabbi Judah he-Hassid, Berakhot 60a; Tosf. Bava Kama 85a, s.v.she-nitnah.”

[6] Moshav Zekenim, Ex. 21:19.

[7] Resp. Da`at Cohen, par. 140; Ein Ayah, Berakhot 60a.

[8] Rashi on Bava Kama 85a, s.v.netanah”; Tosf. loc. cit., s.v.she-nitnah.”

[9] Rabbi Yaakov Tzahalon, Otzar ha-Hayyim, Introduction, s.v.Teshuvah.”

[10] Maimonides, Sefer Ha-Katzeret [Treatise on Asthma]. Also see his Commentary on the Mishnah, Pesahim 4.9. Also cf. Hokhmat Adam 151.25.

[11] Midrash Shemuel, ch. 4, par. 7; Midrash Temurah, ch. 2, also cited in Rashi’s Sefer ha-Pardess.

[12] Zohar, Part III דרצ"ט, Hebrew translation.

[13] Cf. Nedarim 41b.

[14] Nahmanides, Torat ha-Adam, Sha`ar ha-Sakanah; Tur Shulhan Arukh Yoreh De`ah 336.1.

[15] Deut. 22:2.

[16] Bava Kama 81b; Sanhedrin 73a.

[17] Maimonides, Commentary on the Mishnah, Nedarim 4.4; Nahmanides, Torat ha-Adam, Sha`ar ha-Sakanah.

[18] Lev. 19:16. Also Rabbi Yaakov of Orleans, cited in Tosf. Rabbi J. He-Hassid and Tosf. Rosh on Berakhot 60a.

[19] Lev. 19:18, also Nahmanides, Torat ha-Adam, Sha`ar ha-Sakanah.

[20] Resp. Tzitz Eliezer, Part V, Ramat Rachel, par. 21.

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